Úvod - Diagnostika a léčba - Antiseizure Medication Therapy - Rescue Medication

Rescue Medication

Rescue medication refers to the single-use or short-term administration of an anti-seizure drug to help stop a seizure in progress. It is typically used when a seizure lasts longer than usual and there is a risk it could progress into status epilepticus (a seizure lasting more than 5 minutes), or multiple seizures occur in rapid succession without full recovery in between.

At the discretion of the treating physician, rescue medication may be prescribed to patients who are at risk of experiencing prolonged seizures. Both the patient and their caregivers are given detailed instructions on how and when to use the medication safely.

Two rescue medications are currently available in our setting:

Rectal diazepam
Buccal midazolam

Both are primarily intended for out-of-hospital use and can be administered by caregivers in emergency situations. These medications are sedatives, meaning they have a calming effect on the brain and are designed to stop the seizure.

Drowsiness is a common side effect following administration.

In rare cases, rescue medication can cause breathing difficulties, which is why it is essential to closely monitor the patient after administration until they have fully regained consciousness.

Rectal diazepam

The medication tubes are intended for use in adults and children aged 6 months and older.

The solution is administered rectally. For children, it should be given with the child lying on their stomach or side, and for adults, in a side-lying position. The applicator should be inserted fully into the rectum (or halfway for children), and the entire contents of the tube should be administered in one single dose.

While maintaining gentle pressure, remove the applicator slowly to prevent the solution from being drawn back in. After administration, it is advisable to hold the patient’s buttocks together for a few moments to ensure the medication is absorbed.

The main disadvantage of this method is that the route of administration may be inconvenient and socially uncomfortable, particularly in public or non-clinical settings.

Buccal midazolam

Syringes containing buccal midazolam, either prepared by the hospital pharmacy or in the form of a registered applicator, are intended for the treatment of children aged 3 months to 18 years.

Prescribing buccal midazolam for adults is possible in specific cases—particularly when rectal diazepam was not tolerated or found to be ineffective during prior use. In such cases, the patient must be fully informed about the method of administration and must provide their consent to this approach.

The solution is administered slowly using a pre-filled applicator into the back of the space between the gum and the cheek. If needed, the dose can be divided in half and applied to both sides of the mouth.

Caregivers are allowed to administer only one dose of buccal midazolam.

If the seizure does not stop within 10 minutes of administration, emergency medical assistance must be sought immediately. It is important to give the empty syringe to the medical personnel so they are informed of the exact dose that was administered.

Buccal midazolam appears to be as safe and effective as rectal diazepam, and according to some studies, it may even act faster and more efficiently in children. However, its clear advantage lies in the ease of administration and greater social acceptability, especially in public or non-clinical settings.

Medications Restricted to Use in Centers of Highly Specialized Care

Medication Withdrawal

Rescue Medication

Need to schedule a follow-up appointment or running out of medication?

Need to schedule a follow-up appointment or running out of medication?